Humans ; Mediastinal Emphysema ; complications ; Paraquat ; poisoning ; Poisoning ; complications ; Pulmonary Fibrosis ; complications ; Subcutaneous Emphysema ; complications

Administration, Oral ; Calcium Compounds ; poisoning ; Humans ; Sulfides ; poisoning

Objective: To investigate the clinical effect of plasma exchange (PE) versus double plasma molecular adsorption system combined with PE (DPMAS+PE) in the treatment of toxic hepatic failure. Methods: A total of 67 patients with toxic hepatic failure who were admitted during the same period of time were divided into PE group, DPMAS+ PE group, and control group. The 22 patients in the PE group were treated with PE alone, and the 24 patients in the DPMAS+PE group were given DPMAS combined with PE. The clinical out-come was compared between the three groups. Results: Both treatment groups had significantly higher clinical response rate and 24-week survival rate than the control group. After treatment, both treatment groups had significant reductions in the serum levels of total bilirubin (TBil) , direct bilirubin (DBil) , alanine aminotransfer-ase (ALT) , and aspartate aminotransferase (AST) , and the PE group had significant reductions in the albumin (Alb) level and activated partial thromboplastin time (APTT) (P<0.05) ; the DPMAS+PE group showed no sig-nificant changes in the Alb level and APTT (P>0.05). There were no significant differences in TBil, DBil, ALT, and AST between the two treatment groups after treatment (P>0.05). After treatment, the PE group had significantly higher Alb level and APTT than the DPMAS + PE group (P<0.05). Compared with the control group, both treatment groups had significant reductions in TBil, DBil, ALT and AST after treatment (P<0.05). Conclusion The two artificial liver support techniques can significantly improve patients' liver function and in-crease their survival rate, and the combined artificial liver support technique can reduce the amount of plasma used.

Early hemoperfusion in poisoned patients can remove poisons rapidly and effectively, which plays an important role in improving the prognosis of patients. The key of hemoperfusion therapy is the safe and effective anticoagulation. The local citrate anticoagulation effect acid is good, it also has little effect on the systemic coagulation mechanism and internal environment of patients, so it is worthy of promotion. We retrospectively analyzed the clinical data and treatment of 273 patients who were poisoned by citrate anticoagulant in the emergency intensive care unit of the Second Affiliated Hospital of Shandong First Medical University, aiming at perfusion of citrate anticoagulant in patients with poisoning. Provide a certain clinical reference.

OBJECTIVETo investigate the different effect of three methods of blood purification for paraquat poisoning patients:hemoperfusion (HP), hemoperfusion combined with hemodialysis (HP + HD), hemoperfusion combined with continuous veno-venous hemofiltration (HP + CVVH).

METHODS72 cases of paraquat poisoning patients were divided into three groups after giving conventional therapy HP group, HP + HD group, HP + CVVH group. Compared the rate of decline concentrations of paraquat in blood, the liver and the kidney damage between before and after blood purification and contrast the mortality in three groups after different method of blood purification.

RESULTSThe rate of decline concentrations of paraquat in blood of the HP + HD group and HP + CVVH group were both significantly greater than the HP group, but this result of HP + HD group has no significant difference compared with HP + CVVH group; Among the three groups of patients after 72 hours, the degree of dysfunction of liver of the HP + HD group and HP + CVVH group were both significantly lower than the HP group, whilely the degree of dysfunction of kidney of the HP + HD group was significantly lower than the HP group and the HP + CVVH group. The survival time of the HP + HD group and the HP + CVVH group were significant linger than the HP group, but the comparison among the three groups had no significant difference in mortality.

CONCLUSIONThree blood purification methods can effectively remove paraquat absorbed into the blood, and the hemoperfusion combined with hemodialysis or continuous veno-venous hemofiltration can effectively reduce the degree of damage of liver and kidney and also can prolong survival time, but did not significantly improve the survival rate of patients.

Hemofiltration ; methods ; Hemoperfusion ; Humans ; Kidney ; Liver ; Paraquat ; blood ; toxicity ; Renal Dialysis ; Survival Rate ; Treatment Outcome